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No. 3 (2024)

GENERAL THERAPY QUESTIONS AND REVIEWS

Long-Term Consequences of Psychopharmacological Treatment in Adolescence: Minimizing Potential Risks

Published 2024-09-30

  • M.Yu. Popov

M.Yu. Popov
V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology of the Ministry of Health of the Russian Federation

Abstract

Available neurobiological and experimental data suggest that psychopharmacological drugs administered during adolescence can change the trajectories of normal, genetically determined neurodevelopment. The aim of this paper is to review pharmacotherapeutic approaches aimed at minimizing the neurodevelopmental risks associated with psychopharmacological treatment of adolescents. The critical role of monoamine systems in neurodevelopment suggests potential risks associated with the use of monoaminergic drugs. Clinical studies demonstrate differences in the efficacy, tolerability and safety of those drugs between adolescents and adults. Most of these differences relate to antidepressants, which in young patients may increase suicidality while reducing depression symptoms only slightly comparing to placebo. Accordingly, the following general principles of psychopharmacological treatment of adolescents are justified: limited use of antidepressants as first-line treatment; the choice of selective serotonin reuptake inhibitors, if antidepressants are needed; reducing the duration of treatment with antidepressants and antipsychotics; permissibility of the long-term treatment with mood stabilizers (if clinically relevant and well-tolerated); avoiding underdosing and unreasonably slow up-titration. Assessment of the risk/benefit ratio of psychopharmacological treatment in adolescents is very complex. Exposure to medications during the period of vast (neuro) physiological changes introduces additional risks (metabolic, endocrine, reproductive, neurodevelopmental). Conversely, due to high neuroplasticity of the developing brain, adolescence can be considered as a unique “window of opportunity” for effective therapeutic interventions including prevention of further progression of the disorder. Studies evaluating long-term efficacy and safety of psychopharmacological drugs in the treatment of various psychiatric disorders in adolescents are needed.

Keywords

adolescence, psychopharmacological treatment, risk/benefit ratio, neurodevelopment, metabolic risks

PDF (Русский)

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